Objectives – Define depression (symptoms) – Learn how to ask strengths-based assessment questions – Identify a range of potential causes for depression – Explore activities and interventions that can help people address some of the underlying causes

Depression Assessment – What does this mean to you- (apathy, sadness, mood swings) – Which symptoms are most bothersome for you and why- – For each symptom – What makes depression worse- – What makes depression better- – How was life more pleasurable prior to getting depressed- – What is different during when you are NOT depressed- – How do you expect life to be different when your depression is gone- Neurotransmitters – Ability to feel pleasure/Apathy/Emotional Flatness – Memory issues – Difficulty concentrating – Sleep issues – Lack of motivation – Fatigue – Pain – Irritability/Agitation – Fight or flight stress symptoms

Neurotransmitters – Get quality sleep – Create a routine – Address pain and apnea – Improve the sleep environment – Other factors: Shift work, time zones, daylight savings time – Relaxation – Biofeedback – Progressive muscular relaxation – Address medication side effects – Psychotropics – Opiates – Improve nutrition Neurotransmitters – Address addictive behaviors – Address chronic or extreme stress – Refresher – Both of these increase the amount of neurotransmitters flooding the synapses. – To protect the body from overload, the brain shuts down some of the receptors so the body does not overload (tolerance/desensitization) – When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out. – Things that normally caused a reaction, no longer are strong enough to cause a reaction Hormones – Thyroid – Impact mood, libido and energy levels – Estrogen – Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span. – Increased estrogen may increase the availability of serotonin Behavioral and Cognitive Neuroscience Reviews Volume 4 Number 1, March 2005 43-58 – Low testosterone may be implicated in reducing the availability of serotonin – Testosterone is manufactured by the adrenal glands, – Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.

Hormones – Cortisol – Cortisol is made by the adrenal glands. – Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure. – Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”). – DHEA – DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function. Dr. Elise Schroder http://womeninbalance.org/about-hormone-imbalance/hormones-101/

Hormones – Get a physical to identify and address what may be causing any imbalances – Eat a low-glycemic diet – “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life. Hormones – Final Thoughts on Hormonal Imbalances: – Hormonal imbalances affect many millions of people – Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and noticing changes in your sex drive, focus and appetite – Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress, genetic susceptibility, and toxicity – Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress

Pain – Exercise – Guided imagery – Muscle Relaxation – Alternate focus – TENS therapy – Physical therapy – Hydrotherapy – Ice/Heat – Hypnosis Emotions – Anger/Resentment/Jealousy/Envy/Guilt – Anger is half of the fight or flight – It pushes people away and/or asserts dominance/control – Excessive anger can – Exhaust the stress-response system – Contribute to negative cognitions – Impair relationships – Cause physical harm Emotions – Anger/Resentment/Jealousy/Envy/Guilt – Activity (Group or Individual) – When you are angry, what do you notice- – What are your anger triggers- – Why do those triggers make you feel vulnerable- – Is it an external threat- – Is it an internal threat- – How can you address each trigger to feel safer and more empowered- Emotions – Anger/Resentment/Jealousy/Envy/Guilt – Jealousy and envy can be thought of as: – Anger at someone else for having something you want – Self anger for not having it – Existential anger for the universe not being fair – Activity – Make a list of people you envy or are jealous of- – Identify why you are jealous of them- – In what way are they better or better off than you because of those things- – How does envy/jealousy affect you- – What is a more productive way to use this energy Emotions – Anger/Resentment/Jealousy/Envy/Guilt – Guilt can be thought of as shame, embarrassment or self-anger for something you did or should have done – Some people have difficulty letting go of guilt because they think – They deserve to suffer – If they forgive themselves they might do it again

Emotions – Anger/Resentment/Jealousy/Envy/Guilt – Activity: Guilt – Make a list of things you feel guilty about (aka fearless moral inventory) – How can you: – Make amends- – Learn from it- – Forgive yourself- – Activity 2: Forgiveness – What does forgiveness mean to you- – How does the concept of forgiveness make you feel – What does the phrase “Forgiveness is for you” mean- Emotions – Anxiety – Anxiety is the other half of fight or flight – Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain – This causes the body to adapt to excessive stress chemicals by shutting down the receptors –> apathy – Anxiety makes it harder to sleep -exhaustion – hormonal imbalances – depression

Emotions – Anxiety – Activity – For each of the following fears, identify three situations in which you experience it – Rejection/Isolation – Failure – Loss of control – The Unknown – Explore why those situations trigger anxiety – Brainstorm ways to deal with them Emotions – Grief – Grief is sadness/depression experienced as a result of loss – The grief process involves – Anger (at self, other, existential) – Depression – Helplessness to change the situation – Hopelessness that you will move on – Losses are not just about death

Why I Care/How It Impacts Recovery – We experience emotions through neurochemical signals – Imbalances in the neurochemical system –> problems in mood, concentration, energy, libido, sleep and eating behaviors – imbalances in the neurochemical system – Depressive symptoms are huge triggers for relapse – Identifying what causes these neurochemical imbalances for each individual and addressing them is crucial to recovery – What helps- – What makes it worse- – What is different when the problem doesn’t exist- Apply It – Identify 3 ways you could have used this information in the past week. – What intensified your depression over the last week – What made you happy or helped you feel better – If you would have had this new information, what could you have done differently- – How would that have helped you feel less depressed- – How can you start integrating this knowledge into your routine Summary – Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain. – What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above. – Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms – Biopsychosocial means – Examining all causative factors – Recognizing that all factors are reciprocal in nature.

AllCEUs started providing affordable CEUs and counseling continuing education, including online ceus and webinar based counseling ceus, in 2006 to help counselors licensed by their state board of professional counseling or state board of alcohol and drug abuse access affordable counselor continuing education, meet their continuing education requirements and enhance their addiction or mental health counseling practice. Since then, other companies have joined the marketplace to provide lpc continuing education including quantumunitsed, ce4less, Aspira aspirace, tzkseminars, i-counseling, accessceu, CEUbynet, pdresources. AllCEUs pioneered the model of offering unlimited CEU packages for a flat rate. We also were the first to offer live webinars each week for $5 per counseling webinar. We pride ourselves on having the largest catalog, with well over 200 multimedia, online counseling CEU courses. AllCEUs is an approved continuing education provider by the Connecticut Certification Board, The Florida Certification Board, FCB, The Alcohol and Drug Abuse Counseling Board of Georgia, ADACB-GA, NAADAC, the association for addiction professionals, the Texas Board of Social Work, The Texas Board of Professional Counseling, The Texas Board of Marriage and Family Therapy, California Consortium of Addiction Programs and Professionals, the Florida Board of Social Work, Mental Health Counseling and Marriage and Family Therapy and many other boards. It is important to note that, in most states, CEUs are NOT required to be NBCC approved, and most states accept ceus which are NOT from an NBCC approved continuing education provider or ACEP. For specific information about which other approval bodies your state accepts, you can visit our approvals page: https://cdn1.allceus.com/wp-content/uploads/2017/01/NewStateApprovalChart2017-1.pdf which provides a summary and links to the documents of the various state licensing boards for counselors, therapists and social workers. For mental health counselors, social workers and marriage and family therapists in Florida, AllCEUs reports your counseling CEUs to CE Broker. Whether you are a LCSW, MSW, LMFT, LMFT LMHC, LPC, LPCC, LCPC, CCMHC, MHC, CADC, LADC, CAP, LCDC, recovery coach, psychotherapist, pastoral counselor, addiction counselor, substance abuse counselor, recovery specialist, behavioral health technician needing mental health or addiction counseling CEUs online, or wanting to get certified as an addiction professional, AllCEUs has a variety of affordable online counseling CEUs, online addiction counselor certificate training tracks and face to face training options. Our unlimited CE packages provide professional counselor continuing education (CEUs) in addiction counseling, transdisciplinary foundations of addiction counseling, screening and assessment, diagnosis, family therapy, pharmacology, psychopharmacology, case management, crisis intervention, counseling tools, dialectical behavior therapy, mindfulness, acceptance and commitment therapy, ethics, supervision, working with adolescents, and many more.